Scaling, integrating & better supporting people with mental disorders to engage in employment &/or education
Australians with severe and persistent mental disorders experience some of the highest rates of unemployment. Yet people who live with these mental disorders want to work. The evidence demonstrates that engaging in meaningful work improves not only their health but their access to the financial, social, and other resources necessary to improve their mental health and quality of life whilst reducing dependency on the health and welfare systems. There are several reasons that finding and maintaining employment is difficult for this group.
As the majority of severe mental disorders emerge before 25 years of age, schooling and vocational education is often disrupted if not completely derailed. Low educational attainment is linked with negative employment, health, and wellbeing outcomes, that compounds for young people over their lifetime.
The evidence indicates that existing welfare assessment processes misclassify many people with mental disorders, and this results in them receiving inadequate levels of support. Furthermore, the difficulties of coordinating services across health, education and welfare systems raised in multiple reports largely remains meaning that many people living with mental disorders do not get the support they need to break the pattern by re-engaging with education and securing meaningful employment.
Many people with mental disorders who meet eligibility criteria to access disability employment services (DES) report that recovery-oriented practices were not consistently implemented within these services. Indeed, recent data shows that only 10% of people with a psychiatric disability using DES will maintain employment for six months. Existing employment services for people with mental disorders cost Australia more than half a billion dollars each year and are not effectively supporting people with mental illness into work.
People living with a wide range of mental health conditions also report the negative impact of widely held misperceptions and stigma about mental disorders and employment. For people living with mental disorders, this often results in a lack of encouragement from health professionals to participate in employment. In addition, employers often lack the knowledge of simple accommodations to better support employees living with mental disorders. This creates further barriers to successfully gaining and maintaining meaningful employment.
Improving outcomes for this group requires a multifaceted approach. This includes evidence based interventions to support people living with mental disorders to secure and maintain meaningful employment. Moreover, addressing low employment outcomes requires reforms that better support young people with mental disorders to stay in school and where a young person’s education has been derailed completely, providing supports to re-engage with education that aligns with their vocational aspirations.
The evidence strongly demonstrates that the most effective intervention to improve employment outcomes for people with mental disorders is the Individual Placement and Support (IPS) program. Peer-reviewed studies from Australia and around the world have consistently shown that the IPS model achieves better employment outcomes than those achieved by the current Disability Employment Services (DES) model. Whilst IPS is frequently utilised to help people with mental disorders gain and maintain employment, it has been shown to be effective with other cohorts who need more support (such as veterans). IPS has been successfully trialled in Australia and has been expanded as a service offered within 50 Headspace youth mental health centres. In addition, it is available through some DES providers.
The vocational specialists employed within IPS programs have an important role. When located within mental health services, these specialists reinforce the valuable part employment plays in recovery, and this can help alter misperceptions held by health workers. Vocational specialists can provide knowledge and support to employers about reasonable accommodations for employees with mental disorders and, more generally, contribute to breaking down stigma in society.
There are fewer peer-reviewed interventions targeting school-aged young people to remain in school, or where they have disengaged with the school system, to engage with vocational education. Recently, a modification of the IPS program was piloted in Australia to investigate whether the principles of IPS could be applied to assist youth with mental disorders to reengage with education (IPSEd). This program showed promising results. The Victorian Doctors in Schools pilot program has also demonstrated promising outcomes within the first 12 months of implementation. This program locates doctors within the secondary school environment to help students access healthcare. The evidence suggests that co-locating services improves integration between services, reduces barriers and improves access.
Building upon the many successful trials of IPS, the next step is to establish a national high fidelity IPS rollout that expands the program, making it available more widely to include adults and to fully align with the zero-exclusion principle of IPS. Integrating services within schools that support good mental wellbeing and encourage young people with emerging and diagnosed mental disorders to stay in school is a complementary and necessary policy.
